Clearing the Mist: How to Treat Bipolar Brain Fog Without Destabilizing Your Mood

It can be an effect of the disorder itself, of medications used to manage bipolar, or sometimes both, says Alex Dimitriu, MD, a psychiatrist in private practice and a medical reviewer for Everyday Health.

"Patients frequently describe this as 'cognitive dulling,' where processing speed slows down and focus becomes difficult to maintain," he explains. Here's a look at contributing factors, along with strategies that may help clear the mist.

Brain fog can also be a side effect of mood stabilizing medications such as lithium, valproate, and lamotrigine, which are crucial for many with bipolar, Dimitriu says. Some of the atypical antipsychotics that are approved by the U.S. Food and Drug Administration (FDA) for bipolar disorder can contribute as well. That's because of the way these drugs act on the chemicals that relay nerve signals in your brain.

Another factor is the cumulative impact of repeated mood episodes, says Jonathan Terry, DO, a psychiatrist and the assistant dean at California Health Sciences University College of Osteopathic Medicine in Clovis, California. When you have frequent relapses, chronic inflammation in your brain and nervous system can change what’s called synaptic plasticity: the ability of your brain to make the neuron connections that are important for learning and memory, he explains.

Cognitive dulling in bipolar disorder goes beyond feeling distracted, forgetful, or disorganized, Dr. Terry says.

"Patients frequently describe it as thinking through 'molasses' or 'quicksand,' where there is a slowness in cognitive processing," he says. "There can also be a profound sense of mental fatigue, difficulty with finding the right words, and an inability to maintain focus on complex tasks. For many high-functioning professionals, this cognitive slowing can be more distressing than the mood symptoms themselves."

Worth noting is that after someone has experienced a manic or hypomanic episode, what may feel like sluggish thinking could actually be "normal" cognitive function returning, adds Dimitriu.

"When the adrenaline is gone, they feel almost sleepy," he says. "The reality here is that this is what it feels like to be relaxed. Sometimes it takes getting used to a slower pace, especially early on, in treating the condition."

If your mood stabilizer is causing brain fog, it may be possible to adjust the dosage, timing, or both, says Rehan Aziz, MD, a psychiatrist at Jersey Shore University Medical Center in Neptune, New Jersey.

"Some medications are better tolerated than others, so switching medications may be an option," he explains. "There are less-sedating mood stabilizers that can be helpful. Additionally, newer antipsychotics such as lurasidone and cariprazine show early evidence for potentially improving cognitive function in people with bipolar disorder."

It’s crucial that any drug changes be made in collaboration with your physician or health team, Dr. Aziz emphasizes. There are currently no FDA-approved medications specifically designed to treat brain fog in bipolar disorder.

"This is an excellent, non-pharmacological option for patients with bipolar," says Terry. "It helps patients develop compensatory strategies to navigate their daily lives, effectively 'rehabilitating' the cognitive effects that medication alone cannot reach."

Your everyday habits can also play a major role in managing brain fog, according to Terry.

"Lifestyle is not adjunctive, it is foundational," he says. "Protecting the circadian rhythm is the most effective way to stabilize the brain's internal clock, so sleep is the top priority for managing bipolar disorder and minimizing cognitive dulling."

Reducing stress is another key variable, Aziz says. Acute or chronic stress can trigger mood episodes, which can not only make cognitive function more difficult, but may require additional medication that adds to the dulling effect.

"It's important to note that while addressing all of these factors can help with brain fog, they are not a substitute for medical treatment,” says Aziz. “Lifestyle changes work best when combined with appropriate medication and ongoing care from a healthcare provider."

• Cognitive dulling is common in bipolar disorder, often caused by a combination of medication side effects and the underlying biology of the condition.
• To help, your doctor may be able to fine-tune your medication dosage and timing, or suggest a different medication entirely.
• When combined with appropriate medication, lifestyle changes can make a significant difference in reducing bipolar-related brain fog.